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Introducing the 3-A Approach to manage stress/distress/grief from situational loss

Addressing family caregivers and their situational loss

What is a family caregiver?

A family member, friend, or neighbor who provides ongoing assistance to a frail or disabled person who is unable to carry out activities of daily living independently.

(Sometimes referred to as informal caregiver or unpaid caregiver)

You are caregiving if you:

  • Do shopping for an aunt.

  • Take your spouse to medical appointments.

  • Remind your grandmother to take her pills.

  • Paying the bills for your parent.

  • Provide relief regularly for another caregiving family member

What is Situational Loss?

Situational loss is the loss of a person, thing, or quality, resulting from alteration of a life situation, including changes related to illness, body image, environment, and death. (Mosby’s Medical Dictionary, 8th edition. 2009)

What is the 3-A Approach?

The 3-A Approach is a process for addressing and managing the stress and distress/grief reaction from situational loss.

An opportunity for family caregivers to be empowered, strengthen resiliency and well-being by assisting them in accommodating and adapting to the stress and distress/grief from situational loss that accompanies the disease progression. Help is provided through applying the components: Acknowledge Assess Assist.

In my studies, my research interests were grief and caregiving. I have followed the grief work of such prominent figures as Dr. Ken Doka, who introduced the term disenfranchised grief* and Dr. Pauline Boss, who pioneered the term ambiguous loss*. This model reflects the teachings obtained from their extensive scholarly discourse on this topic.

*Disenfranchised Grief is a reaction to a loss that is not socially recognized or acknowledged.

*Ambiguous Loss is a situational loss that is confusing or uncertain ("as clear as mud")

Although developed in social work practice with dementia family caregivers, the 3-A Approach can be applied in all caregiving circumstances. In the context of dementia, the loss is particularly ambiguous due to the circumstances where the afflicted individual is physically present but at the same time, psychologically, a changed person.

"S/he is here but not here"

The 3-A Approach was devised using a grounded theory approach, translating existing grief models into clinical directions of practice with family caregivers, providing an understanding on how the manifested grief affects well being and ability to provide care. Obtaining a better understanding allows healthcare workers to be non-judgemental, and empathic in practice with caregivers. For the caregivers, it is empowering in being able to take control in building their resiliency and self-maintenance of their well-being.

Discovered in Social Work Practice

While practicing social work at the Alzheimer Society, it became increasingly evident to me that the grief is an embedded common element among caregivers, influencing their behavior; however, caregiver grief was totally overlooked in clinical practice with caregivers being treated for stress and depression with the ambiguous situational loss not getting addressed. The dilemma with unresolved distress/grief from loss is that the grief will either re-emerge with a magnified reaction at a later date or manifest through physical difficulties such as migraines, ulcers, hiatus hernias, etc. Unresolved grief also leaves the person unsettled, living with a lack of comfort and peace that could have been accomplished through acknowledging assessing and assisting in facilitating the loss.

Addressing situational loss that is not recognized

Realizing the value of clarifying loss in a situation where loss is not evident, I wrote an article introducing the components of Acknowledge, Assess, Assist that serve to explain the unclear aspects of the caregivers experience. Consequently, intervention can be pursued more compassionately through a tool of understanding while guiding caregiver behavior. The article was published in 2007 in the Omega Journal of Death and Dying, Vol. 54. The article is entitled:

Introducing the 3-A Approach: Acknowledge, Assess, Assist

Acknowledge the grief, Assess the impact, Assist through strategies to address the loss and move forward with strength!

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